T4a 喉癌根治性治疗后的失败模式。
Patterns of Failure After Definitive Treatment of T4a Larynx Cancer.
机构信息
School of Medicine, University of California San Diego, San Diego, California, USA.
Division of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA.
出版信息
Otolaryngol Head Neck Surg. 2022 Aug;167(2):274-285. doi: 10.1177/01945998211049211. Epub 2021 Oct 5.
OBJECTIVE
Recurrence is known to predict laryngeal squamous cell cancer (LSCC) survival. Recurrence patterns in T4a LSCC are poorly characterized and represent a possible explanation for observed survival discrepancies by treatment rendered.
STUDY DESIGN
Retrospective database review.
SETTING
Veterans Affairs national database.
METHODS
Patients with T4a LSCC between 2000 and 2017 were identified and stratified by treatment (chemoradiotherapy [CRT] vs total laryngectomy + neck dissection + adjuvant therapy [surgical]). Primary outcomes were locoregional and distant recurrence. Secondary outcomes of overall mortality, larynx cancer mortality, and noncancer mortality were evaluated in Cox and Fine-Gray models.
RESULTS
A total of 1043 patients had comparable baseline demographics: 438 in the CRT group and 605 in the surgical group. Patients undergoing CRT had higher proportions of node positivity (64.6% vs 53.1%, < .001). Locoregional and distant recurrence were less common in the surgical group (23.0% vs 37.2%, < .001; 6.8% vs 13.3%, < .001, respectively); however, distant metastatic rates did not differ within the N0 subgroup ( = .722). On multivariable regression, surgery demonstrated favorable locoregional recurrence (hazard ratio [HR], 0.49; 95% CI, 0.39-0.62; < .001), distant recurrence (HR, 0.47; 95% CI, 0.31-0.71; < .001), overall mortality (HR, 0.75; 95% CI, 0.64-0.87; < .001), and larynx cancer mortality (HR, 0.69; 95% CI, 0.56-0.85; < .001).
CONCLUSION
T4a LSCC survival discrepancies between surgical and nonsurgical treatment are influenced by varying recurrence behaviors. Surgery was associated with superior disease control and improved survival. Beyond the known benefit in locoregional control with surgery, there may be a protective effect on distant recurrence that depends on regional disease burden.
目的
复发被认为可以预测喉鳞状细胞癌（LSCC）的生存情况。T4a 期 LSCC 的复发模式特征较差，这可能是治疗方法不同导致观察到的生存差异的一个解释。
研究设计
回顾性数据库研究。
设置
退伍军人事务部全国数据库。
方法
在 2000 年至 2017 年间，确定并按治疗方法（放化疗[CRT]与全喉切除术+颈部解剖术+辅助治疗[手术]）对 T4a LSCC 患者进行分层。主要结局是局部区域和远处复发。Cox 和 Fine-Gray 模型评估了总死亡率、喉癌死亡率和非癌症死亡率等次要结局。
结果
共有 1043 名患者具有可比的基线特征：CRT 组 438 例，手术组 605 例。接受 CRT 的患者淋巴结阳性比例较高（64.6%比 53.1%，<0.001）。手术组局部区域和远处复发较少（23.0%比 37.2%，<0.001；6.8%比 13.3%，<0.001）；然而，在 N0 亚组中，远处转移率没有差异（=0.722）。多变量回归显示，手术具有较好的局部区域复发（风险比[HR]，0.49；95%置信区间，0.39-0.62；<0.001）、远处复发（HR，0.47；95%置信区间，0.31-0.71；<0.001）、总死亡率（HR，0.75；95%置信区间，0.64-0.87；<0.001）和喉癌死亡率（HR，0.69；95%置信区间，0.56-0.85；<0.001）。
结论
手术和非手术治疗之间 T4a LSCC 生存差异受复发行为的影响。手术与较好的疾病控制和生存改善相关。除了手术在局部区域控制方面的已知益处外，手术可能对远处复发有保护作用，这取决于区域疾病负担。
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